FACT: People living with HIV who are on effective treatment cannot pass on HIV to their sexual partners.

That’s the message at the centre of a campaign against HIV stigma that got a huge boost this week when it began appearing on video advertising screens around Dublin.

A collaboration between the website MASC. and HIV activist group ACT UP Dublin, the campaign features people in Ireland who are living with HIV sharing positive messages about the health and prevention benefits of treatment.

“We are very excited to be working with ACT UP Dublin on the ‘Undetectable = Untransmittable’ campaign. In using our public platform, we hope to assist ACT UP in sharing scientific facts and removing the stigma surrounding HIV today.

It’s very rewarding to be able to use our screen network to help circulate this incredibly important information and create a shift in the language and imagery we use around HIV, its treatment and those living with it.

We are also thrilled to be the media providers for the first ever digital outdoor campaign for U=U in Ireland!”

Using the phrase “Undetectable = Untransmittable” (often shortened to “U=U” or #UequalsU) the campaign is part of an international effort to promote awareness of the fact that effective HIV treatment is also effective HIV prevention.

When someone is on effective treatment for HIV their “viral load” —the amount of virus in their blood—gets very low, sometimes referred to as “undetectable”. A series of large studies have confirmed that when someone’s viral load is undetectable, it’s not possible for them to transmit the virus sexually. That’s true even if condoms, PrEP, or PEP are not used—there’s simply no risk of passing the virus on to a sexual partner.

Quotes from ACT UP Dublin members Tonie Walsh and Robbie Lawlor in the ads highlight the personal impact of U=U, and the positive, bright colour scheme aims to challenge gloomy and outdated ideas about living with HIV.

The ads will run over the next four weeks at a variety of locations in Dublin and Cork including gyms, bars, and key on-street screens.

The launch of the new phase of the campaign comes on the heels of the publication of the results of the PARTNER 2 study at the beginning of May. That study confirmed the results of previous studies and real-world experience—that there is no risk of sexual transmission of HIV with an undetectable viral load—and concluded: “Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.”

The U=U message has been endorsed by hundreds of community organisations, medical bodies, and health authorities including UNAIDS, the US Centers for Disease Control, and the NHS. The HSE says, “If you are taking HIV treatment correctly, achieve and maintain an undetectable viral load, there is effectively no risk of passing HIV onto others.”

In a 2017 editorial, The Lancet HIV described the impact of the international U=U campaign:

U=U is a simple but hugely important campaign based on a solid foundation of scientific evidence. It has already been successful in influencing public opinion, causing more people with HIV (and their friends and families) to comprehend that they can live long, healthy lives, have children, and never have to worry about passing on their infection to others.

ACT UP Dublin has renewed the call for pharma giant Gilead Sciences to stop blocking access to its anti-HIV medication, Truvada. ACT UP demands that Gilead end its efforts to extend its expired patent and significantly drop the price where the patent is still in effect.

Members of ACT UP Dublin gathered outside the High Court in Dublin this morning as Gilead’s legal team arrived for the first day of a trial on the validity of the Supplementary Protection Certificate (SPC) for Truvada. The original patent expired in 2017, but the disputed SPC would extend Gilead’s monopoly on Truvada until 2020 in Ireland.

“A victory in this suit might bring a windfall for Gilead, but it would be a disaster for Ireland’s HIV prevention efforts,” Leavitt warned.

While it is widely anticipated that the Irish court will find the SPC invalid, a ruling in Gilead’s favour could upend plans for provision of PrEP by the State. A draft Health Technology Assessment report from HIQA found that PrEP is safe and highly effective, and—based on the lower prices charged by generic companies—that a PrEP programme would be cost saving for Ireland, noting that “providing PrEP is less costly… than not providing PrEP.”

Scheduled to run for three weeks, the trial is the latest round in a dispute which began in July 2017. In November 2017 the court denied an injunction sought by Gilead to prevent the sale of generic versions of Truvada in Irish pharmacies prior to a ruling on the validity of the SPC.

Truvada—a combination of anti-HIV drugs tenofovir and emtricitabine—is widely used in combination with additional drugs in the treatment of HIV. It is also the only medication approved for use in the prevention method known as pre-exposure prophylaxis (PrEP).

Two generic versions of Truvada—marketed by Mylan and Teva, the defendants in the current litigation—are currently available in Irish community pharmacies, retailing for as little as €50 for a month’s supply. Before the launch of generics in December 2017, PrEP users in Ireland would have had to pay over €400 per month for branded Truvada.

The Irish case goes to trial as Gilead Sciences faces increasing criticism around patent claims for Truvada in the United States. Since last year a coalition of activists has called on the US National Institutes of Health to break Gilead’s patent on Truvada in the US to allow generic manufacturers to enter the market there.

Following revelations in March of unenforced patents held by the US Centers for Disease Control on the use of Truvada as PrEP, US activists have called for the CDC to enforce the patents or use them as leverage to force Gilead to drop the exorbitant price it charges for Truvada in the US.

A group of US senators has also called on the Dept. of Health and Human Services to enforce its patents, decrying multinational companies who reap “billions of dollars in profits without properly compensating the government for its investments.” And last week it was reported that the US Justice Department is reviewing the unenforced CDC patents.

ACT UP Dublin member Andrew Leavitt said, “Gilead’s behaviour has been disgraceful. The high price Gilead demands for Truvada has delayed PrEP access across Europe—including here in Ireland—and continues to be a huge obstacle to access in the US. This is not how a responsible, community-minded company—especially one supposedly concerned about health—should act.”

The draft report—which was released as part of a public consultation—affirms what we already knew: PrEP is safe and highly effective at preventing HIV. But it also offered something new and really exciting: a PrEP programme for Ireland would not just be cost-effective, but actually cost-saving.

That’s fantastic news, and underscores the clear-cut benefits of getting a functioning PrEP programme up and running without further delay.

The draft report was welcomed by the Government, with the Taoiseach and the Minister for Health both reaffirming their commitment to introducing a national PrEP programme this year—although they provided no specifics about *when* exactly this will happen.

HIQA will be taking public feedback on the draft report until

Which brings us to the less encouraging news in the draft report: an Irish PrEP programme will depend on the already greatly overburdened and underfunded existing public sexual health infrastructure to provide the clinical support needed to use PrEP safely and effectively.

The report is blunt, noting that “The primary barriers to introducing a PrEP programme are staffing and infrastructural issues,” and that “significant investment in STI services is required for a national PrEP programme to ensure a safe, sustainable and holistic service”.

We raised precisely this issue with the Minister when we met with him and officials from the Sexual Health and Crisis Pregnancy Programme and the Department of Health last September. As we emphasised in a follow-up email: “The success of PrEP in Ireland largely depends on the ability of existing sexual health services to deliver it properly… it is vital that there be substantial investment to ensure that that these services can expand their capacity and improve their accessibility.”

This has not yet happened. While a slowly growing number of clinics offer support for PrEP users, the demand still far exceeds the capacity of these clinics—and this demand will grow exponentially when HSE begins to cover the cost of the medication.

With HIV diagnoses at an all-time high in Ireland we desperately need a national PrEP programme that makes PrEP freely available and truly accessible across the country. This HTA draft report contains good news, but it also highlights how much more work remains to be done.

We must keep pressure on the Government and HSE to provide the necessary funding to sexual health services to enable them to support PrEP users, and to do so immediately.

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If you’d like to participate in the public consultation you can provide feedback online or download a form here: https://www.hiqa.ie/reports-and-publications/consultation/draft-hta-prep-programme

For information about PrEP for people living in Ireland visit www.getPrEP.online

HIV diagnoses in Ireland reached an all-time high in 2018, according to figures released yesterday by the HSE’s Health Protection Surveillance Centre. At 531, HIV diagnoses in 2018 increased by 8% over the number of diagnoses in 2017, and are 6% higher than the previous high of 502 diagnoses in 2016.

This upward trend is in contrast to declines in other EU countries. In November the ECDC reported that in “the European Union and European Economic Area (EU/EEA) countries reported a decline in rates of new diagnoses, mainly driven by a 20% decrease since 2015 among men who have sex with men.”

ACT UP Dublin member Andrew Leavitt said, “Seeing HIV diagnoses in Ireland rising like this is simply unacceptable. Despite some recent steps forward, Ireland is failing to make progress in bringing down the number of new HIV diagnoses.”

Leavitt continued, “We’ve been waiting for years for PrEP in Ireland, and this is the predictable result of the delay. The Government has committed to rolling out a national PrEP programme in the next few months. These figures underscore the need for the HSE to act swiftly to make PrEP easy to access everywhere in the country.”

Recent reports from the UK and Australia have shown significant reductions in new HIV diagnoses when PrEP is made widely available.

In addition to making PrEP available, access to HIV testing must be greatly expanded. Ireland has a high rate of late diagnoses, reflecting low rates of HIV testing. Community-based HIV testing programmes like the successful KnowNow project should be expanded, rapid HIV testing should be available for free through GPs, and free HIV self-testing kits should be provided—along with robust support services—to help increase rates of HIV testing in Ireland.

Finally, a nationwide campaign is needed to raise awareness and educate the public on the realities of HIV today. Today’s HIV treatments allow people with HIV to live full, healthy lives. And we know that effective treatment not only keeps people living with HIV healthy, but also prevents transmission of the virus to sexual partners. It’s crucial that these messages be promoted, to help combat HIV-related stigma, and to encourage people to get tested.

New HIV diagnoses remain at historic highs in Ireland and current strategies are not making progress against the epidemic. ACT UP Dublin calls for measures to increase HIV testing rates, for funding of effective support services for people living with HIV, and for implementation of a large-scale, accessible national PrEP programme.

Ireland is stuck in a pattern of high rates of HIV diagnosis, severe problems with late diagnosis, and overall lack of funding for HIV prevention and sexual health sevices. Ireland is neglecting its HIV crisis.

The HPSC—the HSE agency that keeps an eye on communicable diseases in Ireland—released its ‘HIV in Ireland, 2017’ report on Friday afternoon. This year’s annual report has been re-designed, improving the presentation of some key data, but the picture it paints is all too familiar.

Since 2015, annual HIV diagnoses in Ireland have remained stubbornly high at around 500 per year, with a total of 492 reported in 2017. The rate of diagnoses per 100,000 people in 2017 was 10.3–right in the middle of the range of 10.1-10.5 that we’ve seenin recent years. This is signficantly higher than the EU/EEA average rate of 5.9 per 100,000.

This year’s report for the first time provides an estimate for the number of people living with HIV in Ireland: 7,205. Of these it is estimated that about 13% do not know their status. (About 85% of people who have been diagnosed are currently attending HIV care.)

Although internationally transgender women are heavily affected by HIV and are considered a key population by UNAIDS, it was not until this year that the HPSC began to collect information about HIV and transgender people. No information is included about trans people in the 2017 report.

We want to highlight several specific areas of concern:

• Late Diagnosis

Late diagnosis of HIV remains a serious problem in Ireland. In 2017, 55% of people diagnosed for the first time (not previously diagnosed outside of Ireland) were recorded as presenting late and 32% had advanced HIV disease. People who are diagnosed late have substantially higher rates of serious health problems, because the virus has had more time to damage their immune systems. As noted in the report: “late diagnosis is associated with a ten-fold increased risk of short-term mortality (within a year of diagnosis).” (p.19)

Among gay and bisexual men who had not been previously diagnosed with HIV, the late diagnosis rate rose from 42% in 2016 to 48% in 2017. Among men and women who acquired HIV through heterosexual sex and who had not been previously diagnosed with HIV, the same figure was around 60% for the second year in a row.

HIV treatment is highly effective at controlling the virus and is available for free in Ireland. Someone diagnosed soon after contracting HIV, with access to care and treatment, can expect to remain healthy and live a normal life span. As an added benefit, effective treatment also prevents transmission to sexual partners.

Yet people in Ireland continue to be diagnosed with HIV only after they are experiencing serious health impacts. The report notes that “among the HIV notifications in 2017, three deaths were reported at the time of HIV diagnosis,” and that “there were 11 deaths reported to the CSO in 2017 where the cause of death was AIDS or HIV”. (p. 16)

• Increase HIV Testing

HIV testing rates need to be increased, and sexual health services more broadly need to be supported.

Sexual health services remain woefully underfunded across the board. While it is important, as the report notes, to increase awareness about the benefits of HIV testing, that awareness must be accompanied by substantial improvements in the accessibility of testing and treatment for HIV and other STIs.

The report indentifies a need “to expand the groups for whom community based rapid testing for HIV is available” (p. 19). The authors of a separate paper on HIV testing among gay and bisexual men in Ireland, also published this week, note that the KnowNow programme—which offers rapid HIV testing in LGBT community settings—“has been successful in reaching people who have not previously tested for HIV”. KnowNow is an exemplary community-based testing programme, and similar programmes should be developed to reach other groups, including especially migrants.

Government should properly support and monitor HIV home self-testing, as well as the implementation of STI self-sampling kits in clinical and home settings. Self-testing can substantially expand access, but it must be properly supported with connections to counselling and care, and it should be provided free of charge.

• Supporting people living with HIV

The report notes that “it is essential to focus on early engagement in care and immediate continuation or initiation of antiretroviral therapy (ART) both for direct clinical benefit and to prevent onward transmission.” (p. 19)

To help people living with HIV connect with care and stay there, robust supports addressing the challenges of living with HIV need to be in place. We need better communication between clinics, and more effective measures to sustain care and engagement with services. Proper sexual health services should be provided along with HIV care.

Crucially, services and interventions that mitigate the harms of pervasive stigma, including high rates of depression and anxiety among people living with HIV, need to be designed and implemented.

The report notes that “the Minister for Health has stated that he is committed to rolling out a PrEP programme in 2019.” Such a programme needs to be accessible at an appropriate scale — reaching thousands — to have real impact. Existing testing and support services cannot meet current demand, much less support the additional demands the PrEP programme will create. Significant investment in sexual health services across the country is needed now, so that PrEP roll out can be effective in the near future.

• A national campaign

There is a need for national campaign to educate the public about the realities of HIV today. This campaign must challenge the dated and misinformed ideas about HIV that contribute to stigma, inform people about the health and prevention benefits of treatment, and educate about the range of prevention tools available today. This campaign must speak to and include people living with HIV and not focus solely on prevention for HIV-negative people.

ACT UP Dublin expresses serious concerns about the HIV self-testing kit (“Autotest VIH”) Mylan has brought to market in Ireland. In this statement, we highlight ways that the product fails to meet World Health Organization (WHO) standards in this area, and we make suggestions regarding how the product should be improved.

Increasing access to HIV testing is a critical part of Ireland’s response to HIV and we believe HIV self-testing (HIVST) holds considerable promise for increasing rates of HIV testing, for connecting people living with HIV to care, and therefore also for reducing new infections. However, it is important that it be properly implemented, in particular, ensuring that consumer and patient interests are protected. We are concerned about a number of serious shortcomings in the way that Autotest VIH is being packaged and brought to market.

Recently, ACT UP Dublin conducted a review of current policy guidelines with respect to HIVST in anticipation of the possible widespread availability of this type of product in Ireland. There are currently no Irish national policy guidelines regarding HIVST. The HSE Sexual Health and Crisis Pregnancy Programme has informed us that it is awaiting guidance from ECDC on a new set of HIV testing guidelines for Europe, which will include guidance specific to HIVST. This means that Mylan’s product is being brought to market in Ireland in the absence of a coherent and well-thought out national strategy encompassing HIVST.

In the absence of relevant national guidelines, we reviewed WHO guidance on HIVST. We looked carefully at the packaging and instructional insert for the Autotest VIH in order to understand how or whether the product fits with current international best practice, as specified by WHO.

Overall, WHO strongly recommends that “HIV self-testing should be offered as an additional approach to HIV testing services”. By increasing the options available, self testing can help increase uptake of HIV testing, particularly among people who are less likely to avail of conventional testing services.

WHO emphasises that to maximise the benefit while reducing potential harms, HIV self testing programmes “should adhere to the WHO 5 Cs: Consent, Confidentiality, Counselling, Correct test results and Connection (linkage to prevention, care and treatment services).” Here we highlight two of particular concern in the Irish context: “counselling” and “connection.”

Counselling

Regarding counselling, WHO advises: “All HIV testing must be accompanied by appropriate and high-quality post-test counselling, based on HIV test results. Quality assurance (QA) mechanisms, as well as supportive supervision and mentoring systems, should be in place to ensure the provision of high-quality counselling.”

In regard to Autotest VIH for Ireland, for the purposes of counselling, users of this product are directed to contact GOSHH in Limerick. However:

This GOSHH service is offered on a very limited, ‘office-hours’ basis. It is not even available over the lunch hour. Moreover, the hours of available counselling are not printed on the external packaging. When we contacted GOSHH outside of office hours, we heard a recording that made no mention at all of HIVST.

It is extremely likely that individuals will use this test not during normal business hours, but during evenings and weekends. The lack of availability of counselling during these times is serious and troubling.

Users of Autotest HIV will be also be provided with information regarding HSE’s HIV helpline by pharmacists. This helpline also has limited hours of consultation. Moreover, if this additional resource is to be provided to users, it should be included in the packaging of the test itself (otherwise it is liable to being misplaced).

We have some additional questions and concerns:

What training or information will be made available to dispensing pharmacists regarding HIV, HIV testing, or how to access HIV care and services? Will pharmacists be able to provide appropriate and accurate support and advice to users of this product?

Because the counselling services offered with the test are not always accessible, it is extremely important that information regarding living with HIV today be included in the product itself. Users should be clearly informed that today HIV is treatable with medications with very few side effects, that people living with HIV have a normal life expectancy, and that people with HIV who are effectively treated cannot transmit the virus. This is especially important in Ireland, where knowledge about HIV is very low, especially in hard to reach populations. It is not unlikely that those receiving a reactive test result will believe that they (a) have AIDS and are (b) likely to die from it. It is absolutely vital that Mylan guard against this misapprehension and the extremely harmful psychological consequences.

WHO advises that HIVST product users be directed to websites and video demonstrations of a product. Autotest VIH directs users to a French-based website and video demonstration. This website and this video should be recreated in a culturally- and market-specific way for Ireland.

Although HSE has no specific guidelines about HIV self testing, the HSE Sexual Health and Crisis Pregnancy Programme did distribute a short statement that noted that because of the 3-month window period “this test is NOT suitable for monitoring individuals taking HIV PrEP.” SHCPP recommends that PrEP users “engage with services for appropriate monitoring and follow up.” This information should also be included in the packaging.

Connection

Regarding connection to clinical care, WHO advises: “Linkage to prevention, treatment and care services should include the provision of effective and appropriate follow-up. Providing {HIV testing} in situations where there is no access or poor linkage to care, including ART, has limited benefit for those with HIV. In the context of HIVST, connection also includes linkage to further HIV testing in a stigma-free community- or facility-based setting, where test results can be confirmed and an HIV diagnosis given by a trained provider.”

It is vital that information about the treatability of HIV be included in information provided with the test kit. It should also be made explicit that care and treatment for HIV is available for free to anyone living with HIV in Ireland.

We insist that Mylan build a website for users of Autotest VIH in Ireland that provides specific, detailed information on where to seek care in the event of a positive test result. This should include details on where and when clinical services are available at various sites across the country. It should also inform users that HIV care and treatment in Ireland is free.

What’s next?

ACT UP Dublin believes that HIV self-testing is a promising new way to increase HIV testing and to overcome some of the barriers to testing and treatment that lead to, among other things, a high rate of late diagnosis in Ireland. We believe a comprehensive and properly instituted national strategy for HIV testing should include national guidelines for self-testing and a programme for making self-testing kits freely available to the most vulnerable communities. Such a strategy should be part of a new commitment from the State and other stakeholders to ‘Get To Zero’: to make zero new HIV infections a realisable goal in the coming decade. Because Mylan stands to make more money from each new HIV diagnosis, government should encourage Mylan to underwrite subsidies to make the kits affordable and easily accessible, whether in Dublin or in Donegal. ACT UP Dublin will continue watching.

[An earlier version of this post included questions regarding the services available to self-test users. We were contacted by GOSHH who provided additional information that addressed those specific concerns and we have removed those questions from the post.]

Marking Irish AIDS Day, ACT UP Dublin and masc.life today launched a new social media campaign highlighting the health and prevention benefits of HIV treatment.

The “We are the solution” campaign features men living with HIV explaining how effective treatment keeps them healthy and eliminates the risk of HIV being passed on during sex.

This new initiative is part of the international “U=U” campaign. That campaign, started in 2016 by the US-based Prevention Access Campaign, promotes the message that “undetectable equals untransmittable”.

When someone is on effective HIV treatment with an undetectable viral load, there is no risk of the virus being transmitted sexually—even when other prevention methods (condoms, PEP, or PrEP) are not used.

ACT UP Dublin Applauds New HSE Statement: People on Effective Treatment Can’t Pass on HIV

New language recently added to the HSE’s “Health A-Z” HIV and AIDS information page offers the strongest statement yet from the Health Service Executive on the prevention power of HIV treatment. Joining UNAIDS, the US CDC, the Lancet journal, Public Health England, and other health authorities, the HSE has placed its official imprimatur on the medical consensus that when a person is on effective HIV treatment there’s “effectively no risk” that they will pass on the virus to a sexual partner.

In the “Treating HIV” section of the revised page the HSE writes that treatment not only “enables most people with HIV live a long and healthy life,” but that “[w]hen the treatment is working properly, there is effectively no risk that a person with HIV can pass on HIV to another person.”

ACT UP Dublin member, Thomas Strong, said, “Knowing that treatment not only keeps us healthy but keeps our partners safe is of enormous value to people like me living with HIV. The risk of passing on the virus is something that weighs heavily on us. It’s reassuring to know that there’s something we can do to eliminate that risk.”

The HSE’s new statement builds on last year’s “Antiretroviral Therapy for People Living with HIV in Ireland” booklet, which noted that “HIV treatment is also beneficial from a population perspective in that it prevents HIV being passed on to others,” and that “for many people living with HIV, the reduction of infectiousness and relief from anxiety about passing on HIV are very important benefits of HIV treatment.”

That publication explained that in the large-scale PARTNER study “people with HIV who were taking treatment with an undetectable viral load did not pass on HIV to their partner.” The Opposites Attract study—which looked specifically at gay male couples—found the same result: no HIV transmissions from someone on effective HIV treatment to partner who was HIV-negative.

ACT UP Dublin was the first organisation in Ireland to become a community partner with the Prevention Access Campaign’s “Undetectable=Untransmittable” initiative. To promote this information, we have organised direct actions, produced educational materials, published articles and produced a short video called Love & Suppression which features a Dublin couple who were part of the PARTNER study.

This news underscores the importance of testing and treatment in an over-all strategy to reduce new HIV transmissions in Ireland.

This post originally distributed as a press release, 24 April, 2018. The original press release can be viewed here.

The Gay Men’s Health Service (GMHS) clinic on Baggot Street in Dublin has provided sexual healthcare services for gay and bisexual men and trans people for 25 years. In the last ten years—as new diagnoses of HIV and other STIs among gay and bisexual men have climbed dramatically—the HSE has slashed the budget for GMHS.

Regular testing and treatment is one of the most effective ways to bring rates of STIs down. But there’s no use telling people to go for testing if they can’t get access to the services they need. Overcrowding and long waits are the norm—and that’s if you’re lucky enough to not be turned away at the door.

Despite the massive budget cuts, despite the challenges of working in a neglected and run-down building, the GMHS has done its best to meet the growing needs of the community. In 2016 they added a new Monday afternoon screening clinic and, last November, a Thursday-morning PrEP support clinic.

These are important steps in the right direction, but we’ve got a long way to go. We need to let the Government and the HSE know how important these services are to the community. We need to see a commitment to increase funding, to expand available services, and to improve the condition of the clinic facilities.

This week community pharmacies in Ireland began stocking a generic PrEP product made by Teva Pharmaceuticals. This medication is available only with a prescription.

PrEP is not currently covered by any HSE scheme so users must pay the full price themselves. Currently reported prices range from €85 to €95 for a bottle of 30 pills.

A list of pharmacies currently stocking Teva’s Emtricitabine/Tenofovir disoproxil tablets is available from HIV Ireland’s PrEP information page. This list is expected to continue to grow, and you can ask your local pharmacy to order it if they do not currently stock it.

Although this is good news for some PrEP users in Ireland—at least those who may be able to afford to buy PrEP at this price—it is important that we recognise that we are still a long way from PrEP being available and accessible to everyone in Ireland who could benefit.

If you are using PrEP it’s important to get proper medical support and a prescription. Currently there are two clinics in Dublin that provide support specifically for PrEP users.

Dublin’s Gay Men’s Health Service on Baggot Street runs a walk-in PrEP support clinic for gay and bisexual men and trans people. They offer information on how to get and use PrEP, along with a consultation with a supportive doctor who can answer questions and provide a prescription. This GMHS clinic is open every Thursday morning from 10am to noon.